Healthcare Provider Details

I. General information

NPI: 1104732064
Provider Name (Legal Business Name): PACIFIC COAST HEALTHCARE EDUCATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE STE R
PORTLAND OR
97239-3822
US

IV. Provider business mailing address

PO BOX 458
BROOKINGS OR
97415-0041
US

V. Phone/Fax

Practice location:
  • Phone: 541-891-4238
  • Fax:
Mailing address:
  • Phone: 541-891-4238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANEL SHAULL
Title or Position: REGISTERED NURSE/OWNER
Credential: RN, BSN
Phone: 541-891-4238